Different feelings of primary caregivers for older family members about receiving assistance from Israeli vs. foreign caregivers.

In the past few decades, the number of older adults has significantly grown in Israel and around the world with the increase in life expectancy. Consequently, many older adults face a gradual deterioration in physical health and mental state, and are in need of support and assistance in their activities of daily living (ADL). In Israel, the number of older adults who are incapable of performing their ADL independently is estimated at 180,000, most of them living in the community (Brodsky, Shnoor & Be’er, 2012). While they continue receiving informal care – mostly from  family members – a steady rise is noticed in the number of applications for assistance by formal caregivers, under the long-term care benefit of the National Insurance Institute (The National Insurance Institute of Israel, 2013).

Because the number of potential local caregivers is insufficient, and given the ongoing globalization processes, a situation has emerged in which migrant workers from developing countries are invited to come to Israel as caregivers for older adults, offering a comprehensive solution for this problem (Eckstein, 2010; Shor & Weiss, 2011). While there are many advantages to employing foreign caregivers rather than local ones, these advantages are often accompanied by challenges and issues that have to be addressed.

The participants in the current study were primary family caregivers of impaired older adults, who also employed formal caregivers under the National Insurance Institute long-term care benefit. The study investigated the positive or negative feelings that the employment of Israeli or foreign formal caregivers evoked in the informal caregivers (primary family caregivers) with regard to the care provided to their elderly family member. Families that employed live-in (round the clock) foreign caregivers were compared with families who were assisted by live-out local caregivers as part of the National Insurance Institute long-term care benefit. It was assumed that the differences between the two types of care did not stem exclusively from the different number of hours devoted to the older adults, but also from typically different cultural and personal perceptions of the image and duties of a caregiver, and from general views about old age. To date, very few studies have dealt with this issue, and most of them compared between different types of formal employment (Ayalon & Green, 2013; Chiatti et al., 2013; Iecovich, 2007).

A change in the health of a family member has been defined as a stressful life event (Holmes & Rahe, 1967). The present study is therefore based on the stress model developed by Pearlin, Mullan, Semple, & Skaff (1990). This model maintains that the way a stressful event is dealt with depends on various factors; hence, stress management efforts have different manifestations, and the adjustment to stress varies from one person to the other. The model suggests that the stress management process has three components: Source of stress, defined here as the degree of functional impairment of the older adult, as determined by ADL and IADL dependency tests; intermediary factors, in this case the type of formal care provided to the older adult (foreign or Israeli caregiver), and the extent to which this formal care is considered satisfactory, and manifestations of adjustment to stress, examined here from two perspectives: the negative perspective – the primary caregivers’ sense of burden, and the positive perspective – deriving meaning from caregiving.

215 primary caregivers participated in the research, of whom 110 were assisted by foreign caregivers and 105 by Israeli ones. The participants were selected by a convenience sampling from lists provided by a nursing company with branches throughout Israel. All the participating primary caregivers received self-reporting questionnaires, and the data were collected from them simultaneously.

The research findings revealed a number of differences between the groups. Family members who were assisted by foreign caregivers reported they were more satisfied with the caregiver, and felt less burdened than those who were assisted by Israeli caregivers. No significant differences were found with regard to deriving meaning from caregiving.

The research also revealed a negative correlation between the degree of functional impairment of the older adult and the meaning derived from caregiving: the greater the disability, the less meaning the workers found in their work. No correlation was found between the functional disability of the older adult and the primary caregiver’s sense of burden. However, the type of formal care was found to have a moderating effect on these correlations. In a separate examination of each of the two groups of participants, a significant correlation between the degree of functional impairment of the older person and the sense of burden of the primary caregiver was only found in the group that was assisted by a local caregiver. The same was true of the correlation between the degree of disability of the older adult and the meaning derived from caregiving.

Another finding was that satisfaction with the formal caregiver served as an intermediary factor between the type of formal care and the primary caregiver’s sense of burden. This means that the satisfaction variable had an indirect influence on the sense of burden: it was found that those who were assisted by foreign caregivers were more satisfied and therefore their sense of burden was milder.

A regression equation showed that the main predictors of a sense of burden in the primary caregivers were the age of the older adult, the primary caregiver’s state of health, the number of weekly hours the primary caregiver devoted to the older adult, and the primary caregiver’s satisfaction with the formal caregiver.

Three research variables were found to correlate with deriving a sense of meaning from caregiving: the primary caregiver’s state of health, a diagnosis of dementia in the older adult, and the satisfaction of the primary caregiver with the formal caregiver. The degree of functional impairment of the older adult, the type of formal care provided and the interaction between these two variables were not found to significantly predict a sense of burden or a sense of meaning in caregiving.

The present research is important in that it sheds light on the potentially greater benefits of assistance provided by foreign caregivers compared with local caregivers. The research highlighted the weight of the type of formal assistance provided to the older adult, and has shown it to be a central and significant variable in the research model. This point, which has so far not been explored extensively, indicates that round-the-clock care provided to older adults by foreign caregivers has no less impressive advantages for the family members serving as primary caregivers than for the older adult. The present study joins previous studies conducted in this field (Ayalon & Green, 2013; Ayalon, Green, Eliav, Asiskovitch, & Shmeltzer, 2013; Cohen, 2010; Iecovich, 2007), supporting and confirming their findings. The study investigated in depth the different feelings of primary caregivers assisted by foreign formal caregivers as against those of caregivers assisted by local formal caregivers. It examined both the extent to which they were satisfied with the formal care and the effect of these two types of employment on the feelings of the primary caregivers.

From a political perspective, the present research could be of use to politicians and decision makers, and may impact the regulations and laws they initiate in the matter of inviting foreign caregivers to Israel as a significant workforce in the nursing sector. Another important point that came up in the study is that there is much need to find ways to support both the informal and formal caregivers, who cope for long periods of time with the complex and difficult daily reality of providing comprehensive care to functionally impaired older adults.